HEALTH CARE

New Cervical Cancer Screening Guidelines Call for Fewer Pap Tests

An illustration of health forms under a stethoscope and a pen.
Health care, doctor, hospital patient,(iStockphoto)

Women no longer need an annual Pap test for cervical cancer, a new set of guidelines from the U.S. Preventive Health Services Task Force has concluded.

The highly regarded group of independent scientists, which reviews medical evidence and issues recommendations on preventive health measures, released its guidelines on Wednesday in the Annals of Internal Medicine. The group has now revised downward its cancer-screening guidelines for the three most common cancer tests: mammograms, prostate specific antigen testing, and the Pap.

The guidelines for breast- and prostate-cancer screening got a big backlash, as critics charged that the group—which does not consider cost in its calculations—would harm patients and encourage a rationing of care by suggesting less frequent tests.

The new cervical-cancer recommendation is less likely to generate an outcry. That’s in part because of timing—the task force chose to release its mammography guideline in the heat of the debate over the 2010 health care legislation and “death panels.” It’s also because cervical-cancer screening has worked so well at catching precancerous changes to the cervix that the number of women diagnosed with the disease is very small, and these women are less politically active than breast- and prostate-cancer patients.

The guidelines suggest that women no longer be screened before their 21st birthdays and that women with clear screenings need not continue them after they turn 65. They also recommend against an annual screening test, now the centerpiece of many women’s annual gynecological exam.

ADVERTISEMENT

For healthy women in their 20s, the task force recommends a Pap test every three years. For women 30 and older, it recommends either continued testing every three years with the Pap smear or testing every five years with the Pap and a test for human papillomavirus, the sexually transmitted infection that causes the disease. (Those guidelines differ for women with a history of cervical cancer, certain abnormal Pap results, or immune-system disorders.)

The American Cancer Society released its own updated screening guidelines on Wednesday as well, and they mirror those of the Preventive Health Services Task Force. The American College of Obstetricians and Gynecologists, the physicians’ group, had already issued guidelines calling for the end of annual testing in 2009. But the task force’s recommendation is likely to carry more weight.

Members of the panel recommended the less frequent screenings after determining that women screened on the new calendar have identical rates of cervical-cancer death to those screened annually. But women who are screened more often had a higher rate of false positive tests, cervical procedures, and, ultimately, premature delivery and other complications in pregnancy related to damage done as a result of procedures.

“This is a win-win for women,” said Dr. Wanda Nicholson, an associate professor of gynecology and obstetrics at the University of North Carolina and a member of the task-force panel. “Less screening achieves equal effectiveness, but less potential risk.”

That message—that more screening is not necessarily better—is not always intuitive to Americans, who have been taught that they should get tested for cancer to protect themselves against disease.

But the cervical-cancer data is less murky than the evidence weighed in the case of breast- and prostate-cancer screening. In both of those cases, the task force weighed the comparatively high risk of misdiagnosis and overdiagnosis against a modest increase in mortality. In this case, more screening simply does not improve a patient’s chances of survival.

The panel’s report pointed out, however, that the majority of women who die from cervical cancer were not screened in the last five years. That means that while women with regular access to health care can get the test less often, it’s still important for women who are not getting tested to do so.

Nicholson emphasized that the panel did not consider cost, but if the new guidelines shape patient behavior, they could yield some savings for the federal government, which pays for the Pap test through Medicaid, Title X, Medicare, and its Breast and Cervical Cancer Early Detection Program.